Summer Camp begins Monday, July 9 and run through Saturday, July 21.

Performances will be Friday, July 20th and Saturday, July 21st at 6pm.

Discounts available for multiple children/siblings and active members of the High School Apprentice Program.

Apprentice = 50% discount

More than one child = 25% discount for second child (must pay full amount for first child)

NOTE: Upon Completion of this form, return to our Summer Camp Webpage to pay tuition (Due July 9)

ONE FORM PER STUDENT

A $50.00 non-refundable deposit is required for each class.

This fee will go toward the final cost of the camp

Failure to pay the total amount by the first day of camp will forfeit your child's spot in the camp.

Mandatory Registration Fee

*

$50 - This fee will go towards the total cost of the camp

Student Information

*

First Name

Last Name

Date of Birth

*

(mm/dd/yyyy)

School Attending

*

Parent/Guardian Name

*

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Mailing Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Primary Phone

*

Secondary Phone

Parent Email

*

Secondary Email

Student Email

Does your child have any physical/medical conditions we need to be aware of?

*

Yes

No

If you checked yes, please describe:

Please list any previous performing arts experiences/classes.

*

If you have no previous performing arts experiences, please enter "N/A" in the text box.

Payment Agreement

*

I understand that there is a fee due to Parkway Playhouse. The fee may be paid in installments, with the $50 due at registration and the balance due by the first day of camp in order for my child to be a participant in the class/camp.

I Agree

Photo/Video Release

*

I give permission for Parkway Playhouse to take photos and videos of my child to use for purposes of promoting Parkway Playhouse and its Junior Programming.

Yes

No

Liability Release

*

I understand that performing arts and related activities may present a risk of injury to the
participant. I further understand that the inherent risk of injury cannot be eliminated regardless of the care taken to avoid injury. I
agree to assume that risk in order for child to participate in these activities. The undersigned acknowledges that the participant is in
good health and does not have any history or a medical or physical condition that would place the participant at risk due to the
participant's medical or physical condition. I do hereby release and forever discharge Parkway Playhouse, their predecessors and
successors, employees, agents and assigns, and all other persons, corporations, and entities from all claims, expenses, attorney fees,
and causes of action or suits of any kind or nature associated with the participant's involvement with Parkway Playhouse.By
signing below, I acknowledge that I have given my approval and acknowledge my responsibilities for the above items that I have
initialed.

I Agree

Would you like to donate to the Parkway Playhouse Junior Scholarship Fund?

Yes

No

If yes, how much would you like to donate?

$

Our mission is to inspire, educate, and entertain everyone in the community by providing quality, sustainable theater opportunities.

Parkway Playhouse is a 501(c)(3) organization as designated by the IRS. As such contributions are tax-deductible to the extent and manner allowed by law.

Financial Information about this organization and a copy of its license are available from the State Solicitation Licensing Branch at 919-807-2214 or 888-830-4989 for NC Residents.

3% will be added to your total amount to help cover the payment processing fees